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MRCPUK Endocrinology and Diabetes (Specialty Certificate Examination) Sample Questions:
1. A 43-year-old woman was admitted with right lower lobe pneumonia and was found to have atrial fibrillation. She had a history of bipolar disorder for which she was taking lithium. Her menstrual periods were normal.
Investigations on admission:
serum thyroid-stimulating hormone (TSH)0.98 mU/L (0.4-5.0)
serum free T428.1 pmol/L (10.0-22.0)
serum free T314.2 pmol/L (3.0-7.0)
Assay interference had been excluded.
Subsequent investigations:
serum sex hormone binding globulin64 nmol/L (40-137)
serum thyroid-hormone receptor ?-subunit0.8 IU/L (<1.0)
anti-thyroid peroxidase antibodiesnegative
What is the most likely diagnosis?
A) TSHoma
B) surreptitious ingestion of thyroxine
C) lithium-induced hyperthyroidism
D) thyroid hormone resistance
E) non-thyroidal illness (sick euthyroid syndrome)
2. A 61-year-old woman was found incidentally to have a raised serum calcium concentration. She was otherwise well. Her father had undergone a neck operation many years previously.
Investigations:
serum corrected calcium2.78 mmol/L (2.20-2.60)
plasma parathyroid hormone10.8 pmol/L (0.9-5.4)
Her general practitioner thought she had primary hyperparathyroidism.
Which further finding is most likely to cast doubt upon this diagnosis?
A) normal parathyroid radioisotope scan (sestamibi scan)
B) high serum 25-OH-cholecalciferol
C) normal serum phosphate concentration
D) low urinary calcium excretion
E) low serum magnesium concentration
3. A 60-year-old man with type 2 diabetes mellitus attended for an elective laparoscopic cholecystectomy. His oral hypoglycaemic medication regimen was metformin 1 g twice daily and gliclazide 160 mg twice daily. His haemoglobin A1c concentration had been 69 mmol/mol (20-42) when checked 2 months previously.
He was admitted on the morning of surgery and was on the morning list. He had fasted from midnight and taken metformin 1 g at 05.00 h.
On examination, he weighed 82 kg.
Investigations (on admission):
serum creatinine64 umol/L (60-110)
fasting plasma glucose18.1 mmol/L (3.0-6.0)
capillary blood ketones0.2 mmol/L (<1)
According to the Joint British Diabetes Societies guideline 'Management of adults with diabetes undergoing surgery and elective procedures', what is the most appropriate next step in management to bring his preoperative glucose into the acceptable range (4.0-12.0 mmol/L)?
A) rapid-acting analogue insulin 8 units subcutaneously
B) rapid-acting analogue insulin 16 units subcutaneously
C) variable-rate insulin infusion
D) cancel surgery and refer to local diabetes team
E) gliclazide 160 mg orally
4. A 40-year-old man presented with a 4-month history of increasing central obesity. His medical history included HIV infection and allergic rhinitis. He was taking highly active antiretroviral therapy and nasal fluticasone.
On examination, he had marked central adiposity. His blood pressure was 160/95 mmHg.
Investigations:
serum sodium140 mmol/L (137-144)
serum potassium3.8 mmol/L (3.5-4.9)
serum cholesterol5.5 mmol/L (<5.2)
fasting serum triglycerides8.20 mmol/L (0.45-1.69)
serum cortisol (09.00 h)<50 nmol/L (200-700)
serum thyroid-stimulating hormone4.6 mU/L (0.4-5.0)
serum free T49.3 pmol/L (10.0-22.0)
What is the most likely diagnosis?
A) HIV-associated lipodystrophy
B) glucocorticoid resistance
C) hypothyroidism
D) Addison's disease
E) Cushing's syndrome
5. A 67-year-old man underwent an isotope bone scan after being found to have a raised serum alkaline phosphatase (of bone origin). The blood test had been ordered because of mild lower back pain, which had now resolved. He was not taking any medication.
Examination was normal.
Investigations:
isotope bone scansee image
What is the most likely diagnosis?
A) fibrous dysplasia
B) prostate cancer
C) multiple myeloma
D) osteomalacia
E) Paget's disease
Solutions:
Question # 1 Answer: D | Question # 2 Answer: D | Question # 3 Answer: A | Question # 4 Answer: E | Question # 5 Answer: E |